September 19, 2019
Shock 7, Dehydration in children

Shock 7, Dehydration in children

Oh diarrhea and vomiting is a common problem in children very often caused by violent gastroenteritis but it can be caught can be caused by bacterial gastroenteritis as well so how we’re going to manage this because make no mistake this is a life-threatening condition in children it’s a very common cause of death especially in young children they lose fluids through diarrhea vomiting and of course as they’re losing fluids they’re also losing electrolytes so how we’re going to manage this well the first in key message is that the the mother should continue breastfeeding get all the breast milk into the baby or the child that the child will accept carry on breastfeeding that’s absolutely essential that will give the child fluids it will give the child nutrients and it can also reduce the amount of diarrhea so breast milk is very beneficial and in fact encouraged foods pretty well all source the only thing we really don’t want to give fizzy drinks because if we give carbonated fizzy drinks that can fill the stomach up and stretch the stomach and trigger the vomit reflex so certainly don’t give them fizzy drinks but other than that pretty well any drinks that the child likes now the nice guidelines in the UK we recommend not giving fruit juice because it’s acidic and it can cause further information in the inflamed lining of the gastrointestinal tract but the facts for life published by the World Health Organization say that you should give fruit juices and I’m take to go with the World Health Organization thinking because of children who have diarrhea and vomiting as well as becoming dehydrated often become hypokalemic they lose potassium and of course that in itself is a life-threatening condition so fruit juices will replenish some of the potassium but certainly no fizzy drinks but if the diarrhea persists at all or even to give off electrically is a good idea all the rehydration salts are the key treatment now what will be hydration salts very simple all you need is some clean water some sugar and some salt and that will make a very simple rehydration solution that you can make at home more sophisticated commercial ones also contain potassium and some bicarbonate and the key thing about warmer rehydration solutions containing all the rehydration salts is that they massively increase the rates of absorption of fluids from the gut into the blood I’m just going to show you how they work let’s imagine we have the lumen of the intestine here this could be their basement membrane with the endothelial cells on it individual cells lining say the duodenum this might be the other side of the journey at the end and these are the cells which comprise the mucosa and this would be the lumen of the gastrointestinal tract here and in the submucosa we have many many Canaries of blood vessels looping very near these cells so blood is brought in via arterial vessels goes through these capillaries leaves by a venous vessels now the key thing is if there’s just water in the gutter intestinal tract here that will be absorbed into these cells and from there we’ll go through the mucosa into the submucosa into the blood therefore contribute to infant vascular volume but that happens relatively slowly but if there’s glucose in the solution the glucose is taken into these cells here by active transport mechanisms it doesn’t just have to diffuse in it’s an active process in other words these cells lining the Gustin Steindl tractor using energy to grab the glucose and to pull it in and this happens quickly it’s active transport so the glucose is actively transported across the membranes of the cells of the mucosa of the gut it’s grabbed and pulled in using enzymic ATP powered mechanisms so that means you get fairly high concentrations of glucose in the cells which line the mucosa very quickly and of course the glucose is an osmotic molecule so that sucks the water in so any water molecules though here are something very quickly via osmosis because osmosis is a dilution effect osmosis waters down so the water in the goat seeks to water down the relatively sugary cytosol in the cells which are lining the gastrointestinal tract so the water moves very quickly when weighing more quickly than it would without the sugar present so that means that the water has got very small distance now to go to defuse from the moon comes up to the capillaries in the submucosa so you can get fairly quick into that vascular fluid resuscitation giving all the rehydration solutions as long as they contain the the sugar glucose or sugar both will have the same effect and as well as that would could put some salt in it which replaces the salt and if there’s potassium in it that also replaces the lost potassium so all of rehydration salts really have been a major breakthrough in the treatment of gastroenteritis in children if the child won’t take me the dreams that you can consider giving a nasogastric low RS but if you give it frequently very small amounts maybe feeding the child with a spoon just small amounts but very frequently then you can prevent the dehydration from developing and even if it’s developed you can treat it because of this rapid absorption of the water because of the active transporter that the glucose molecules now if that’s not working if the child is getting worse then we might need to think about intravenous therapy and we would think about intravenous therapy when the child presents with so-called red flag symptoms things that were just taught to do something fairly quickly and if the child was very poorly or deteriorating we might take that as a red flag and go on to intravenous fluids or if the child had reduced responsiveness or reduced levels of consciousness that’s a red flag symptom or if the eyes are are shrunken that’s a sign of dehydration or of the charge tachycardic bearing in mind the normal heart rate for the child’s age of course even if it goes beyond that if there’s a tachycardia for the child or attack of Nia that’s also a red flag symptom rapid respiration another one that’s worth keeping an eye on insurance is his skin turgor if the skin loses its elasticity and the charge skins sort of puckers up a bit like an old person skin me that means that the child might need to go onto intravenous therapy but for most children or we hydration solutions containing oral rehydration salts are very often enough thankfully if the Island Hospital care receiving intravenous fluids we need to check the usual things Soniya we don’t want to want the job to be hyponatremic we don’t want the sodium to be low potassium hypokalemia is a life threatening feature we also want to check the urea and creatinine to make sure that the renal function is adequate and it’s also worth checking glucose levels because hypoglycemia is a complication of gastroenteritis in children as well as the dehydration now if the child will carry on eating during this period then small amounts of food are probably a good idea mashed up food that the child likes you might remember when you’re in as a child yourself maybe among gave you some ice cream or some something nice something that’s nice to me that the child likes because of continuing nutrition is very important and then as soon as the the jars better we need to give them normal food and extra food to build them up and the child is not fully recovered from the episode of gastroenteritis until their weight is back up to what it was before the child became ill you

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